Medication management gives athletes a sporting chance 

Effectively managing the medication and health of elite athletes is always the right medicine for their sporting success. 

However it’s often difficult when high-performance athletes – and support staff – are travelling overseas or need medication to treat medical or chronic conditions that can impact their performance.

Fortunately, Australia’s top athletes and coaches have expert medical and healthcare support, as well as pharmacy dispensary services, available through the Department of Sports Medicine at the Australian Institute of Sport (AIS) in Canberra.

The medical clinic helps manage the performance of Australia’s athletes in the international sporting arena by providing evidence-based and innovative sports medicine support.

Senior AIS sports physicians consult with athletes about injuries and illness, and help to manage and treat all aspects of injury and illness prevention.

The innovative Sports Medicine facility is designed to help prepare athletes to be at their optimum health to excel at their chosen sport.

Registered nurses also make a major contribution to athlete care by being responsible for dressing injuries, providing immunisations, taking blood and dispensing medications.

The nursing staff also supervise and maintain the AIS pharmacy, which is strongly supported by Capital Chemist at Lyneham in the ACT.

AIS Chief Medical Officer Dr David Hughes – who oversees the day-to-day functioning of Sports Medicine and its medical research program – spoke with Australian Pharmacist during a recent visit to the medical clinic.

Dr Hughes highlighted the integral role of health professionals – including pharmacists – to ensure peak performance for all the elite athletes based at the AIS.

‘We know that injury and illness have a significant impact on performance – particularly going into competition time,’ Dr Hughes told Australian Pharmacist.

‘When you’re competing, you don’t want to be knocked around by being unwell.

‘We also provide care for additional people – officials and other sporting administration people. ‘A lot of what we do is education around good hygiene, especially when large teams are travelling together.’

One of the main areas of the Department of Sports Medicine is the in-house pharmacy which operates a little differently to most mainstream community pharmacies.

AIS dispensary

The AIS pharmacy functions more like a dispensary utilising a unique in-house prescription system, where a doctor prescribes a medicine order that is then dispensed and electronically recorded on the athlete’s file.

‘It really functions more like a dispensary than a pharmacy – and we work really closely with Lyneham Capital Chemist,’ Dr Hughes said.

‘They are fantastic – they provide an excellent service – and are able to do things at short notice, including advice on the latest developments in medicines.’

While the AIS clinic stocks a fairly standard range of common medicines including for conditions like asthma, colds and flu, inflammation and minor ailments, Dr Hughes said the relationship with the local community pharmacy is imperative, especially when they need to stock medications that are specific to individual needs.

‘We value this collaboration with medicines experts and enjoy dealing directly with a pharmacist,’ Dr Hughes said.

The nursing staff at the AIS predominately manage the dispensary with Registered Nurse Ruth Fazakerley taking the lead.

Ms Fazakerley provides nursing support to athletes visiting the Sports Medicine Clinic as well as manages the handling and storage of medicines.

The high-tech facility has a two bed observation area, which is like a “sick bay” but the clinic and health centre is not open after hours or on weekends.

‘Our pharmacy is very much a dispensary – and that’s where it’s a little bit different to mainstream pharmacies,’ she said.

‘A lot of the athletes are quite young and this is the first time they’ve been away from home so the doctors won’t prescribe a full pack of any medicine. They are all short doses – and doctors will usually only give the amount until their next review of the athlete.

‘They don’t give a script with repeats – and they [athletes] are monitored closely.’

Ms Fazakerley said once the medication is dispensed, it’s recorded against an athlete’s file and they are given a receipt.

‘When we’re giving the medication we provide advice, and we remind them they can reduce their risks by going online and checking their substances through the Australian Sports Anti-Doping Authority (ASADA) website.’

Apart from the pharmacy, the clinic also provides a range of healthcare services including musculoskeletal ultrasounds, minor procedures, skin lesions, stitching lacerations and vaccinations.

Vaccination

To ensure athletes reach and perform at their peak, especially when travelling overseas, vaccination is critical to their success.

The sports medicine clinic provides a large number of vaccinations and travel vaccinations for athletes, especially in the lead-up to major international sporting events, including the Rio Olympics in 2016.

‘We provide all vaccinations that the athletes might need and for their support staff,’ Ms Fazakerley said.

‘We stock all the major vaccines and also provide expert advice on how to be safe and self-reliant in overseas countries to limit and reduce symptoms of travel illness.’

For vaccines, the clinic predominantly deals with the Canberra-based pharmacy as well as the Federal Government but ‘we did directly deal with vaccine companies before the Rio Olympics.’

In the lead up to Rio in 2017, it’s estimated the clinic vaccinated more than 850 people including athletes and support staff, who had to be vaccinated for a range of conditions including yellow fever.

Dr Hughes said there were also precautions taken following the outbreak of the Zika virus before the Olympics.

Medication Policy and travel medicines

To ensure all athletes take medication safely, the Sports Medicine clinic follows a strict Medication Policy – with a major focus on only dispensing the bare minimum amount of medication required for athletes.

‘We don’t like them wandering around with bags full of medication – fortunately not many athletes are on long-term medicines,’ Dr Hughes said.

It can often be challenging for the medical staff, especially when they are dealing with young athletes aged from about 14 years old.

There are also strict protocols around prescribing pain and sleeping medications.

‘Like any pharmacy, we potentially face the same issues with people doctor shopping, so we have pretty strict rules around the use of strong pain medicines and sleep medication,’ Dr Hughes said.

‘We have a Medication Policy around some of these issues and in all cases we try to address symptoms through non-pharmacological methods in first instance.

‘But if an athlete’s travelling, we have a general rule we will only hand out three days of any particular sleeping medication at a time.’

To help athletes self-manage conditions, they are also encouraged to meet with the doctor before travelling overseas.

‘We encourage athletes to check medicines before they leave – and in most cases, athletes come and check in with us beforehand,’ Dr Hughes said.

‘We put together a travel medical kit, which depends a lot on where they are travelling.’

These travel packs usually include small amounts of paracetamol, nasal spray, vitamin c, zinc supplements and a throat gargle – with some instructions so they can ‘self-manage their conditions’.

‘We do also operate a bit like a travel clinic,’ Ms Fazakerley said.

Anti-doping regulations

Another major focus of the medical clinic and pharmacy is ensuring athletes comply with Australian and world anti-doping regulations.

This is governed by the World Anti-Doping Agency (WADA) and ASADA, based in Canberra.

A key role for the clinic is educating athletes on which drugs and substances are banned for competition and keeping a close eye on the everchanging rules.

Dr Hughes said athletes are constantly reminded about the therapeutic use exemption system used by WADA as well as the Global Drug Reference Online (Global DRO) which provides athletes and support personnel with information about the prohibited status of specific medications based on the current World Anti-Doping Agency (WADA) Prohibited List.

‘With Global DRO – athletes can go there and tap in medication and see if it’s banned in sport,’ Dr Hughes said.

To also ensure prohibited medications really stand out, they are labelled with a bright pink label to show they are prohibited during competition.

‘We have to have them brightly labelled,’ Ms Fazakerley said.

During the year, the athletes are also regularly reminded about prohibited substances and the changes that come into effect on a national and global level. These updates are sometimes provided through information pamphlets and brochures.

Supplements and complementary medications can also be challenging for athletes to comply with antidoping regulations.

‘For anybody who comes here for a medication review, supplements can be an issue. We really try to educate them around that – but it’s difficult because there’s so many supplements on the market,’ Dr Hughes said.

He said the clinic generally tends to use the same brands of supplements which have been batch tested for compliance.

Mental health is another key practice area for the clinic, especially dealing with young adults and adolescents who are under pressure to perform at their best.

‘We do deal with mental health issues – it’s tricky as the athletes are away from home – and we’re discussing with parents who are distant so there’s an extra duty of care,’ Dr Hughes said.

The Department of Sports Medicine also works closely with other disciplines of Performance Support services to deliver integrated support services to Australia’s athletes.